Affordable care that isn’t affordable

[Sun Devil 92]

Some of it sure, but it's all been accelerated and institutionalized in large part due to the ACA. The old fee-for-service world has started to melt away because of the ACA. We're now firmly moving into a world of value-based purchasing, risk-based contracting, and accountable care. That's a big deal and it's a big shift.

I'll address the graph in a moment.

Value based purchasing...by who ?

I don't buy anything.

I get health insurance.

My company's plan has not changed nor have they asked me to do anything different in the last 10 years.

The only change has been that they now offer a high deductible plan coupled with an HSA.

Obamacare is throttling the FSA's though.

Your sentences read like greek.

Risk based contracting...by who ?

This sounds like B to B language. What does that mean to a consumer ?

You've referenced "accountable care" prior and given repeat admittance as a metric. Fine. My wife, a nurse (who has chosen to take some time off), has indicated that hospitals play all kinds of games with defnitions so as to classify patients according to whatever works to their interests. While I am not saying "accountable care" is a bad thing.....I am saying don't kid yourself.

But first, it would be great to be able to go to a place and understand what this means.

 

[Sun Devil 92]

Some of it sure, but it's all been accelerated and institutionalized in large part due to the ACA.

What is the hard evidence that supports this comment.

That is what is at the crux of things.

As an example:

I started a thread that asks about the inefficiency people bleated about prior to the ACA and asked where that is now.

The basic premise there was that we had 30% of all costs that could be eliminated.....which meant health care costs should come down by that much...and so should health insurance.

Is Obamacare getting at that ?

If so, shouldn't our spending be down ?

It's not....or seems to be not.

 

[Greenbeard]

Your sentences read like greek.

Well, I can explain what this means, I can give you the background and context, I can tell you what's happening right now and why it's a big deal. You can get a brief 101 on health care in the U.S. But I don't think you want that. I'll waste time doing that and you'll breeze on to the next thing, none the wiser.

If you want to understand what's going on, fine. But don't jerk me around here.

 

[Sun Devil 92]

At the same time, as deductibles rise you've got more people becoming price sensitive to anything priced below the deductible.

Which is a nice way of saying people will think twice about going to the doctor.

I was always for higher co-pays.

But I don't like the way deductibles work now.

To many are letting things go because they will pay for full price for visits they should be making.

 

[Sun Devil 92]

Your sentences read like greek.

Well, I can explain what this means, I can give you the background and context, I can tell you what's happening right now and why it's a big deal. You can get a brief 101 on health care in the U.S. But I don't think you want that. I'll waste time doing that and you'll breeze on to the next thing, none the wiser.

If you want to understand what's going on, fine. But don't jerk me around here.

Yes, I don't want you to describe things the way you do.

It's a waste of both our times.

I've tried to digest your data in the past, but I don't have the same set of references you do.

Consequently, it means little to me (which isn't saying it is correct....I just have no way of knowing).

But when you use terms like "Risk Based Contracting", I have to ask just why should that be important to me.

Clearly you know what you are saying.

I have no idea what you are talking about.

 

[dblack]

Sure. But a decline in price growth isn't. It's just slower price growth. Spin your horseshit equivocation elsewhere.

I was talking about a particular set of services.

You were 'spinning' bullshit is what you were doing. You're a propagandist, full stop.

 

[Sun Devil 92]

Sure. But a decline in price growth isn't. It's just slower price growth. Spin your horseshit equivocation elsewhere.

I was talking about a particular set of services.

You were 'spinning' bullshit is what you were doing. You're a propagandist, full stop.

While I may not disagree with your, in general (I simply can't tell because I can't relate to much of what is posted), I have to disagree with you analysis on this point.

The graph shows one variable that is negative. This would only be possible if the price that year was less than the price the year below...if I read the graph right.

 

[Greenbeard]

At the same time, as deductibles rise you've got more people becoming price sensitive to anything priced below the deductible.

Which is a nice way of saying people will think twice about going to the doctor.

I was always for higher co-pays.

But I don't like the way deductibles work now.

To many are letting things go because they will pay for full price for visits they should be making.

You've got co-pays and deductibles backwards. A copay is a flat fee for going, it doesn't send any price signals to the consumer. It's basically just a small barrier to going (do you want to go bad enough that paying the flat fee is worth it?), it doesn't help you decide where to go.

A deductible, on the other hand, can.

Imagine three providers in your city offering the same service, but pricing it very differently (which is what actually happens in cities all across the country). You have a $500 deductible.

[TABLE="class: grid, width: 500"][TBODY][TR][td][/td][TD]Provider A[/TD][TD]Provider B[/TD][TD]Provider C[/TD][/TR]
[TR][TD]Procedure Price[/TD][TD]$1,200[/TD][TD]$3,400[/TD][TD]$5,000[/TD][/TR]
[TR][TD]Your share[/TD][TD]$500[/TD][TD]$500[/TD][TD]$500[/TD][/TR][/TBODY][/TABLE]
In this case, it doesn't matter which provider you see when it comes to price because you're not exposed to the actual price of the service.

Indeed, if you were actually shown this information by your insurer in advance while deciding where to get the procedure, you might even be pulled toward the highest priced provider. If you're like most people, you probably assume that Provider C is the highest quality provider (they likely have high name recognition and a well-known reputation to go with the market clout that allowed them to secure that higher price). In the absence of quality information, people tend to equate price with quality in the health care market. Even though the evidence suggests that's not quite how things work.

But let's say your deductible was higher and this is your situation:

[TABLE="class: grid, width: 500"][TBODY][TR][td][/td][TD]Provider A[/TD][TD]Provider B[/TD][TD]Provider C[/TD][/TR]
[TR][TD]Procedure Price[/TD][TD]$1,200[/TD][TD]$3,400[/TD][TD]$5,000[/TD][/TR]
[TR][TD]Your share[/TD][TD]$1,200[/TD][TD]$3,400[/TD][TD]$4,100[/TD][/TR][/TBODY][/TABLE]
Now the answer to the question of where to get the service may have changed because you're more exposed to the price.

There are only so many ways to put downward pressure on Provider C's prices--deductibles are the option that does it by letting the consumer decide whether that higher price is worth it.

The potential downsides are that 1) people need to have disposable income for the "skin in the game" concept to work, and 2) as you point out, they may not have the information or know how to assess the risks well enough to weigh whether it's worth it to get care in the first place. Doing it this way assumes a lot of the consumer.

I've tried to digest your data in the past, but I don't have the same set of references you do.

That would be the point of explaining it in more depth.

 

[Sun Devil 92]

At the same time, as deductibles rise you've got more people becoming price sensitive to anything priced below the deductible.

Which is a nice way of saying people will think twice about going to the doctor.

I was always for higher co-pays.

But I don't like the way deductibles work now.

To many are letting things go because they will pay for full price for visits they should be making.

You've got co-pays and deductibles backwards. A copay is a flat fee for going, it doesn't send any price signals to the consumer. It's basically just a small barrier to going (do you want to go bad enough that paying the flat fee is worth it?), it doesn't help you decide where to go.

A deductible, on the other hand, can.

Imagine three providers in your city offering the same service, but pricing it very differently (which is what actually happens in cities all across the country). You have a $500 deductible.

[TABLE="class: grid, width: 500"][TBODY][TR][TD]Provider A[/TD][TD]Provider B[/TD][TD]Provider C[/TD][/TR]
[TR][TD]Procedure Price[/TD][TD]$1,200[/TD][TD]$3,400[/TD][TD]$5,000[/TD][/TR]
[TR][TD]Your share[/TD][TD]$500[/TD][TD]$500[/TD][TD]$500[/TD][/TR][/TBODY][/TABLE]
In this case, it doesn't matter which provider you see when it comes to price because you're not exposed to the actual price of the service.

Indeed, if you were actually shown this information by your insurer in advance while deciding where to get the procedure, you might even be pulled toward the highest priced provider. If you're like most people, you probably assume that Provider C is the highest quality provider (they likely have high name recognition and a well-known reputation to go with the market clout that allowed them to secure that higher price). In the absence of quality information, people tend to equate price with quality in the health care market. Even though the evidence suggests that's not quite how things work.

But let's say your deductible was higher and this is your situation:

[TABLE="class: grid, width: 500"][TBODY][TR][TD]Provider A[/TD][TD]Provider B[/TD][TD]Provider C[/TD][/TR]
[TR][TD]Procedure Price[/TD][TD]$1,200[/TD][TD]$3,400[/TD][TD]$5,000[/TD][/TR]
[TR][TD]Your share[/TD][TD]$1,200[/TD][TD]$3,400[/TD][TD]$4,100[/TD][/TR][/TBODY][/TABLE]
Now the answer to the question of where to get the service may have changed because you're more exposed to the price.

There are only so many ways to put downward pressure on Provider C's prices--deductibles are the option that does it by letting the consumer decide whether that higher price is worth it.

The potential downsides are that 1) people need to have disposable income for the "skin in the game" concept to work, and 2) as you point out, they may not have the information or know how to assess the risks well enough to weigh whether it's worth it to get care in the first place. Doing it this way assumes a lot of the consumer.

I've tried to digest your data in the past, but I don't have the same set of references you do.

That would be the point of explaining it in more depth.

I get that.

My statement was poorly worded.

What I was saying is that if you have not used your deductible, you might not go at all. It's simply to expensive (that being a, of course, a relative term).

I think that deductibles should be progressive in nature. That means that you should not have to pay it all before you get help. Especially when it comes to preventive care.

 

[basquebromance]

Kentucky to dismantle its ObamaCare marketplace
ObamaCare costs set to spike for thousands

 

[JakeStarkey]

One, dblack and Sun Devil have offered nothing to support the OP.

Two, the stats have been provided to show that the inflation curve for medical costs continue to flatten.

Three, the march to single payer for everyone is inevitable.

 

[dblack]

One, dblack and Sun Devil have offered nothing to support the OP.

More of your inane sportscasting. Piss off Fakey.

 

[JakeStarkey]

dblack is losing it again.

The full quote was, "One, dblack and Sun Devil have offered nothing to support the OP.

Two, the stats have been provided to show that the inflation curve for medical costs continue to flatten.

Three, the march to single payer for everyone is inevitable."

dblack continues to

 

[Sun Devil 92]

One, dblack and Sun Devil have offered nothing to support the OP.

More of your inane sportscasting. Piss off Fakey.

Put her on ignore.

I did a long time ago......

I have found that if you read her posts.....your I.Q. suffers.

 

[Sun Devil 92]

Kentucky to dismantle its ObamaCare marketplace
ObamaCare costs set to spike for thousands

It appears to be cost shifting.

And those who are eating the extra costs are not those making above 250K as promised.

 

[dblack]

One, dblack and Sun Devil have offered nothing to support the OP.

More of your inane sportscasting. Piss off Fakey.

Put her on ignore.

I did a long time ago......

I have found that if you read her posts.....your I.Q. suffers.

Meh.. I don't need software to ignore the twits. I just swat them for fun when it amuses me.

 

[JakeStarkey]

 

[JakeStarkey]

As long as dblack and sun devil et al talk stupidly, they are appropriately dealt with.

Opinions are fine, but don't believe they are evidence of anything other than your opinion.

 

[Sun Devil 92]

One, dblack and Sun Devil have offered nothing to support the OP.

More of your inane sportscasting. Piss off Fakey.

Put her on ignore.

I did a long time ago......

I have found that if you read her posts.....your I.Q. suffers.

Meh.. I don't need software to ignore the twits. I just swat them for fun when it amuses me.

Agreed, but it cuts down the effort required to find useful posts.

None of hers are useful......easy peasy.

 

[JakeStarkey]

dblack and Sun Devil continue to chase their